Revisiting the musculocutaneous external oblique flap as a versatile alternative in large thoracic wall defects

David Matera,Amir B Behnam,Terrance Hanley,Richard Huynh

doi:10.1186/s40792-019-0708-4

David Matera, Amir B Behnam + Show 2 more

Open Access

https://doi.org/10.1186/s40792-019-0708-4

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Abstract

BackgroundThe external oblique myocutaneous flap has been previously described for reconstruction of chest-thoracic wall defects smaller than 400–500 cm2. However, it is utilized less often than workhorse flaps such as the omental, pectoralis, rectus abdominis, and latissimus dorsi myocutaneous flaps as many plastic surgeons are not aware that the flap can cover larger areas than previously documented.Case presentationWe report a 57-year-old female tobacco user who underwent a resection of a grade 3 breast angiosarcoma resulting in a high left chest wall soft tissue defect approximating 900 cm2. The patient underwent an external oblique myocutaneous pedicle flap reconstruction of the defect, most notably in anticipation of postoperative adjuvant radiation therapy. No gross flap complications and or patient impairment were noted. Thirteen months status post flap reconstruction, the patient underwent an aortic valve replacement requiring re-elevation of the same flap for exposure. The flap demonstrated excellent viability during the procedure and postoperatively.ConclusionThe pedicled external oblique myocutaneous flap should be considered when reconstructing larger high chest wall defects when other more common flaps used in chest reconstruction may not be indicated. The external oblique myocutaneous flap is an excellent tool in the armamentarium of any reconstructive surgeon; it is a straightforward and versatile flap that can be safely and reliably used in durable reconstruction of defects of the chest wall and covers defects larger than previously described in the literature.

Highlights

The external oblique myocutaneous flap has been previously described for reconstruction of chestthoracic wall defects smaller than 400–500 cm2
The pedicled external oblique myocutaneous flap should be considered when reconstructing larger high chest wall defects when other more common flaps used in chest reconstruction may not be indicated
We report on a patient with a chest wall soft tissue defect measuring 900 cm2 (30 cm × 30 cm) after angiosarcoma resection, in whom an ipsilateral pedicled EOM flap was used for reconstruction of a large chest wall defect, which was re-elevated 1 year later for an aortic valve replacement

Summary

Conclusion

There are multiple techniques in reconstructing complex chest wall defects resulting from a variety of factors including cancer. Segmental arteries derived from the 5th– 12th posterior intercostal arteries form the minor segmental vascular supply to the external oblique. This dual blood supply contributes to the flaps’ dependability as noted by the viability of the flap even after re-elevation, 13 months after the original procedure. Given the orientation of the external oblique, it is easier for the plastic surgeon to rotate the flap cephalad, making it more ideal for reconstruction of upper chest wall defects given this limited arc. As many authors before us, agree that the EOM flap is a reliable, harvested flap with great versatility in providing stable durable coverage of larger defects of the chest than previously believed

Background